Medicare Premiums and IRMAA: What You Need to Know for 2026

If you’re on Medicare — or getting close to it — you’ve probably noticed your premium isn’t always the same as your neighbor’s. That’s usually thanks to something called IRMAA. It sounds intimidating, but once you understand how it works, it’s actually pretty simple to plan around. Here’s what it is, how it’s calculated, and what it means for your wallet in 2026.

What is IRMAA?

IRMAA stands for Income-Related Monthly Adjustment Amount. It’s a surcharge added on top of your standard Medicare Part B (medical insurance) and Part D (prescription drug coverage) premiums if your income is above a certain level. In plain terms: the more you earn, the more you may pay for the same Medicare coverage everyone else has.

IRMAA isn’t a penalty or a mistake — it’s simply how Medicare is funded to keep premiums more affordable for lower- and middle-income beneficiaries.

The 2026 baseline: what everyone pays

For 2026, the standard Medicare Part B premium is $202.90 per month. The average standalone Part D premium is $34.50 per month. If your income is below the IRMAA thresholds, that’s all you pay — no surcharge involved.

How IRMAA is calculated

Here’s the part that trips people up: IRMAA isn’t based on your income this year. It’s based on your Modified Adjusted Gross Income (MAGI) from two years earlier. So your 2026 premiums are determined by your 2024 tax return.

MAGI, for IRMAA purposes, is your Adjusted Gross Income (Form 1040, Line 11) plus any tax-exempt interest income (Form 1040, Line 2a) — things like municipal bond interest. That add-back catches some retirees off guard, since tax-exempt income still counts toward the IRMAA calculation even though it isn’t taxed.

2026 IRMAA brackets

For 2026, the surcharge kicks in once MAGI exceeds $109,000 for single filers (and those married filing separately) or $218,000 for married couples filing jointly. Here’s the full breakdown:

Single filers / Married, filing jointly (MAGI thresholds)

Single filer MAGI	Married filing jointly MAGI	Part B surcharge	Total Part B premium	Part D surcharge
$109,000 or less	$218,000 or less	$0	$202.90	$0
$109,001 – $137,000	$218,001 – $274,000	$81.20	$284.10	$14.50
$137,001 – $171,000	$274,001 – $342,000	$202.90	$405.80	$37.50
$171,001 – $205,000	$342,001 – $410,000	$324.60	$527.50	$60.40
$205,001 – $499,999	$410,001 – $749,999	$446.30	$649.20	$83.30
$500,000 or more	$750,000 or more	$487.00	$689.90	$91.00

If you’re married and file separately, the brackets are much narrower — MAGI above $109,000 puts you straight into a much higher surcharge tier, so that filing status deserves extra attention during tax planning.

Why IRMAA works like a “cliff”

One of the most important things to understand about IRMAA: it’s a cliff, not a gradual phase-in. If your MAGI is even $1 over a threshold, you pay the full surcharge for that entire bracket — not just on the amount over the line. That makes it worth watching carefully in years when you’re close to a threshold, especially around one-time income events like a large capital gain, a big Roth conversion, or the sale of a home or business.

How to plan ahead and reduce IRMAA exposure

Because IRMAA looks back two years, the best planning happens well before you actually enroll in Medicare. A few strategies worth discussing with your accountant or financial advisor:

Roth conversions done strategically, ideally before Medicare enrollment or during lower-income years, can reduce taxable withdrawals later and help keep your MAGI under future thresholds.

Balancing withdrawals across taxable, tax-deferred, and tax-free (Roth or HSA) accounts gives you more control over your MAGI each year.

Qualified Charitable Distributions (QCDs) can offset the impact of required minimum distributions if you’re charitably inclined.

Timing large one-time income events, such as a property sale, can help you avoid pushing MAGI over a threshold in a single year.

What if your income drops?

If you’ve had a major life change — retirement, divorce, the death of a spouse, or a significant income reduction — you don’t have to wait two years for IRMAA to catch up. You can file Form SSA-44 with the Social Security Administration to request a reassessment based on your current circumstances rather than your two-year-old tax return.

The bottom line

IRMAA can add a meaningful amount to your Medicare costs, but it’s predictable and plannable. Because it’s driven by a tax return from two years prior, proactive tax planning today can directly reduce what you’ll pay for Medicare down the road. If you’re approaching Medicare eligibility or expect a income spike in the next year or two, now’s the time to talk with your accountant about how it might affect your future premiums.

This post is for general informational purposes and isn’t personalized tax or financial advice. Talk with your accountant or financial advisor about how IRMAA applies to your specific situation.

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Source: Medicare Premiums 2026: IRMAA Brackets and Surcharges for Parts B and D — Kiplinger